by Michelle Healy, USA TODAY

by Michelle Healy, USA TODAY

Parents who sign consent forms for medical or dental procedures on their children often do so with trepidation. For many, that concern likely increased in recent weeks with reports that seemingly commonplace procedures - in one case a tonsillectomy, in another, dental work - ended in two children's deaths.

Tonsillectomy-related fatalities are not common; they occur in the "1 in every 30,000 range," says physician Richard Rosenfeld, director of the Institute for Advanced Otolaryngology at New York Methodist Hospital in Brooklyn.

About 530,000 tonsillectomies a year are done on children younger than 15, down considerably from 30 years ago when the number peaked at around 1.5 million, Rosenfeld says.

The decline is due primarily to a shift away from doing the surgery as a treatment for recurring throat infections such as strep throat, he says, "We know from randomized controlled trials that the efficacy for this is significant but not as great as what was previously thought."

Currently the primary indication for the surgery is when enlarged tonsils obstruct breathing at night, causing either sleep-disordered breathing or obstructive sleep apnea, "in which a child literally is not getting oxygen when asleep," Rosenfeld says.

That was the case for Jahi McMath,13, who was declared brain-dead by physicians at Children's Hospital Oakland in December after surgery to remove her tonsils and treat other tissue to improve her breathing.

One of the most common complications associated with the surgery is severe bleeding, and that "would be the most common reason for the 1 in 30,000 deaths," Rosenfeld says.

"It's not a minor, trivial procedure but a serious surgery" that occasionally has tragic results, he says. "You only want to have tonsillectomy if there is broad agreement between the specialist, your primary care doctor and you as a parent that this is really the right thing to do."

The most recent mortality statistics on tonsillectomies are not new, but similar data for pediatric dental procedures are even more difficult to find.

"I don't know if those numbers exist, when you consider the millions of dental procedures that are done every day with no untoward effect," says Warren Brill, president of the American Academy of Pediatric Dentistry. "Fortunately, it happens very rarely."

Although there's no national reporting mechanism in place to gather those numbers, a Virginia Beach, Va., advocacy group lists 45 children who have died as a result of dental office emergencies since 1974.

Finley Boyle, 3, of Kailua, Hawaii, who died this month after massive brain damage following multiple dental procedures, is not yet included in that count, but her case sounds similar to many of others on the list, says Nicole Cunha, executive director of the Raven Maria Blanco Foundation in Virginia Beach.

The foundation is named after Cunha's cousin, who died at age 8 after a 2007 dental visit for a routine checkup and cleaning. An emergency developed when, according to the autopsy, Blanco was given three times the prescribed amount of a sedation medicine, Cunha says.

In nearly all of the cases listed on the site, "regardless of whether it was (the result) of a piece of gauze that fell into the airway, a drug overdose, or a tooth that chipped and blocked the airway, the steps taken after the emergency happened is where there was a disconnect," she says. That led to the foundation's focus on medical emergency preparedness, she adds. Among other materials, the foundation offers downloads and checklists of questions that parents should ask when choosing a dentist.

Issues surrounding sedation and anesthesia given to kids at the dentist have long been a concern, and "sedation techniques and safety factors are a large part of pediatric dental specialty education," Brill says. "Many states require special licenses and permits in order to do sedation in the office, and all pediatric dentists get the needed education to meet these requirements."

When sedation guidelines set out in the cademy's reference manual have been followed, "there has never been a known tragic mishap," he says. "Any parent who has sedation recommended by the pediatric dentist should not hesitate to ask questions that will satisfy them that the treatment is needed."

Although Lilly Geyer, the dentist who treated Finley Boyle at Island Dentistry for Children, is not a pediatric dental specialist, it does not mean that general dentists cannot do sedation appropriately, Brill says. "They certainly can do it because they can learn how through various courses within general practice residency. But in this particular tragic situation, that particular doctor happened not to be a pediatric dentist."